Patients don't trust obese doctors and are less likely to follow their advice compared with skinnier physicians, new research shows. The study is believed to be the first to show that overweight and obese MDs are vulnerable to the same "fat phobia" and harmful stereotypes that physicians display toward their overweight patients. Numerous studies have shown that doctors have biased attitudes toward obese people, painting them as "awkward," "unattractive," weak-willed, sloppy and lazy. The stigma, the new study shows, cuts both ways. Researchers surveyed 358 adults online. About half were normal weight, 31 per cent were overweight and 17 per cent were obese. Participants were randomly assigned to receive one of three different surveys that asked about their perceptions of doctors who are normal weight, overweight or obese. They also completed the "fat phobia scale," a measure of fat bias that asks people to indicate how much they endorse or agree with different adjectives to describe people who are obese, such as "poor self control," "no will power" and "weak." Overall, "respondents report more mistrust of physicians who are overweight or obese, are less inclined to follow their (weight-related) medical advice and are more likely to change providers if their physician appeared overweight or obese," the authors report. Slimmer doctors, by comparison, elicited more "favourable opinions." The weight bias held regardless of the person's own body weight. "It's not intuitive - you would think that, as the prevalence of obesity has increased, so would tolerance of people who are struggling with excess weight," said lead author Rebecca Puhl, director of research at the Rudd Centre for Food Policy and Obesity at Yale University. "In fact, the bias has actually worsened over time," she said. "Obesity continues to be misperived as a temporary condition with an easy solution - that someone can simply lose weight," Puhl said. People tend to distance themselves from "the obese" population, she said. "They think, 'This is not me. I can lose weight. I'm not part of this group.'" Efforts aimed at reducing weight bias have been targeting health professionals. "But we need to make sure those efforts are also reaching the public," Puhl said. The study appears in the International Journal of Obesity. Anti-fat stigma is so entrenched, it's not surprising that physicians are themselves vulnerable, says Dr. Arya Sharma, a professor of medicine and chair of obesity research and management at the University of Alberta in Edmonton. "Patients might think, 'This person can't even manage their own weight, why would I trust this guy to give me advice?' "The only way to address weight bias is to get people to understand the complexity of obesity," Sharma says. It goes beyond "eat less, move more" platitudes, he said. "As long as we keep those messages as our central message, we're going to continue promoting weight bias," he said. "Because what we're essentially saying is, 'If you can't do that, you deserve to be fat.' "There are lots of reasons why people have problems controlling what they eat - mental health issues, emotional eating, time-management issues, medications that make people want to eat more," he said. Physicians are no different and have the added pressures of long hours and stressful jobs "where you're not in full control of your time," Sharma said. "I'm in clinic today, and if I don't get time for lunch I know I'll come home starving in the evening and end up overeating. "It's no easier for a doctor to control their weight than anyone else," he added. "But studies show that if you talk about genetics and the complex psychobiology (of weight control), people's weight biases go down."
